Mean Prostate Volume Research Articles

Management of prostatic abscess, our experience over 5 year

Background: The objective of our study was to perform retrospective analysis of management of prostatic abscess in a tertiary care hospital in northeast India.Methods: This was a single tertiary care hospital based retrospective analysis of management of 24 patients diagnosed with prostatic abscess, between January 2015 and January 2020. Diagnosis of prostatic abscess was confirmed by trans-rectal ultrasonography (TRUS) and/or computed tomography (CT) scan/magnetic resonance imaging (MRI) prostate. Various treatment modalities used in our study were conservative, transurethral resection of prostatic abscess (TURP), TRUS-guided trans-rectal drainage/aspiration, trans-urethral drainage (TUD) + trans-urethral incision (TUI).Results: On analysing 24 patients diagnosed with prostatic abscess, mean age was 46.12 years (range, 17 to 73 years), the mean prostate-specific antigen (PSA) was 17.3 ng/ml (range, 2 to 40.0 ng/ml), mean prostatic abscess volume was 33 cubic mm (range, 10 to 75 gm). All patients were hospitalised, on admission all patients were started on intravenous antibiotics (3rd-generation cephalosporin along with an amino-glycoside) or antibiotics as per urine culture report. Diabetes mellitus was most common associated co-morbidity present in almost 50% of patients. Patients presented with dysuria (75%), urinary retention (29%) fever (25%) and perineal pain. Cases were managed by surgical approach after failure of conservative management.Conclusions: Early surgical intervention for prostatic abscess reduces morbidity and mortality associated with it. TRUS guided drainage can be performed under local anaesthesia, are better suited for small localised abscess but associated with increase hospital stay. Trans-urethral drainage are better suited for elderly patient with large prostate volume.

Diagnostic performance of transrectal ultrasound for prostate volume estimation in men with benign prostate hyperplasia

Despite transrectal ultrasound (TRUS) being regarded as gold standard for prostate volume estimation, concerns have been raised in the literature concerning its accuracy especially in men with above-average prostate volumes. We aimed to evaluate the performance of TRUS for prostate volume estimation in a cohort of sub-Saharan African men since they are known to have relatively large mean prostate volumes. This was a prospective study of 77 sub-Saharan African men who had open simple prostatectomy for benign prostate hyperplasia (BPH). Pre-operative TRUS determined total prostate volume (TPV) and transition zone volume (TZV). Following surgical enucleation, the adenoma was weighed (EPW) and its volume (EPV) also determined by fluid displacement. TRUS was repeated six weeks post-operatively to calculate the TRUS-estimated specimen volume (TESV). The mean EPV, EPW, TRUS-estimated TZV, TRUS-estimated TPV and TESV were 79.1 ± 62.9 ml, 79.1 ± 62.9 g, 53.3 ± 28.5 ml, 93.1 ± 48.9 ml and 69.9 ± 44.6 ml, respectively. Pearson's correlation showed a perfect relationship between EPW and EPV with no difference in their mean values (r = 1.000; P < .001). Pearson's correlation between TRUS-estimated TPV vs EPV, TRUS-estimated TZV vs EPV, and between TESV vs EPV were 0.932, 0.865 and 0.930, respectively (P = .0000). TRUS significantly under-estimated the TZV and TESV by 25.8 ml and 9.2 ml, respectively; unrelated to the severity of prostate enlargement. TRUS underestimates prostate volume, independent of prostate size. We propose simple formulae that could be used to improve the prostate volume determination from TRUS, especially if magnetic resonance imaging is not readily available or contraindicated.

Urinary and sexual function after treatment with temporary implantable nitinol device (iTind) in men with LUTS: 6-month interim results of the MT-06-study.

To evaluate the functional outcomes as they relate to the preservation of urinary continence and sexual function after treatment with the temporarily implanted nitinol device (iTind; Medi-Tate Ltd, Israel); a novel minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Men with symptomatic BPH (IPSS ≥ 10, Qmax < 12ml/s, and prostate volume (PV) < 120ml) were invited to participate in this single-arm, prospective multicenter study (MT06). Patients were not washed out of BPH medications before the procedure. The iTind was implanted through a 22F rigid cystoscope under intravenous sedation and was removed 5-7days later through a 22F Foley catheter under local anesthesia. Post-operative VAS and complications (Clavien Dindo-Grading System) were recorded. Preservation of urinary continence and erectile and ejaculatory function were assessed according to ISI, MSHQ-EjD and SHIM questionnaires. Post-operative IPSS, QoL, Qmax and PVR were also assessed at 1, 3, and 6months post-operatively. This interim report includes data out to 6months on the first 70 patients enrolled in the study. The median age was 62.31years, and the mean prostate volume was 37.68ml (15-80ml). Baseline and follow-up data are reported in Table 1. No intraoperative complications were observed, the average post-operative VAS score was 3.24 ± 2.56. On average patients returned to daily life after 4.3days following the retrieval procedure. Sexual function and urinary continence were preserved in all subjects according to the ISI, SHIM and MSHQ-EjD questionnaires and significant improvements (p < 0.0001) from baseline levels were recorded in IPSS, QoL and peak flow. iTind is a well-tolerated, minimally invasive treatment for BPH-related LUTS which preserves sexual function and urinary continence, offers a rapid recovery and return to daily life, and a significant improvement of symptoms and urinary flow at 6-month follow-up.

Stress Urinary Incontinence post-Holmium Laser Enucleation of the Prostate: a Single-Surgeon Experience.

ABSTRACTPurpose To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP).Materials and Methods We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI.Results 52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, 44 men (70.9%) with incontinence were catheter dependent preoperatively. Mean prostatic volume was 148.7mL in tSUI patients, 111.6mL in long-term SUI, and 87.9mL in others (p <0.0001). On univariate analysis, laser energy used (p <0.0001), laser “on” time (p=0.0204), resected prostate weight (p <0.0001), overall International Prostate Symptom Score (IPSS) (p=0.0005), and IPSS QOL (p=0.02) were associated with SUI. On multivariate analysis, resected prostate weight was predictive of any SUI and tSUI, with no risk factors identified for long-term SUI.Conclusion Post-HoLEP SUI occurs in ~10% of patients, with 1.5% continuing beyond six months. Most patients with tSUI recover within the first six weeks. Prostate size >100g and catheter dependency are associated with increased risk tSUI. Larger prostate volume is an independent predictor of any SUI, and tSUI.

The inflammation patterns of different inflammatory cells in histological structures of hyperplasic prostatic tissues.

BackgroundThe distribution characteristics of inflammatory cells in hyperplastic prostatic tissue and its influences on disease development remain unknown. We aimed to explore the infiltration characteristics of different inflammatory cells in histological structures of benign prostatic hyperplasia (BPH) in combination with clinical data.MethodsThe present study included 76 cases of BPH patients underwent transurethral resection of prostate (TURP). Hematoxylin-eosin staining was performed to identify the degree of general inflammation in prostatic tissues. The infiltration of T-lymphocytes (CD3), B-lymphocytes (CD20), and macrophages (CD68) were recorded by immunohistochemistry.ResultsThe present study included 76 BPH patients with the mean age of 69.5 years old (range, 49–83 years) and the mean prostate volume of 91.9 mL (range, 24–218 mL). Periglandular inflammation was the most common pattern, being presented in 94.7% (72/76) patients, followed by stromal inflammation (67/76, 88.2%) and glandular inflammation (57/76, 75.0%). However, the stroma presented the highest rate of severe inflammation (14.6%). And the grades of glandular inflammation and stromal inflammation were independently correlated with prostate volume. T-lymphocytes, B-lymphocytes and macrophages had different infiltrated patterns in histological structures of prostate. And stromal hyperplasia dominated BPH was only significantly correlated with the T-lymphocytes infiltration condition (P=0.001). Meanwhile, overweight patients had more severe glandular inflammation in the prostate (P=0.010). The grade of glandular inflammation could independently increase prostate-specific antigen (PSA).ConclusionsWe characterized infiltrated patterns of different inflammatory cells in histological structures of hyperplasic prostatic tissues from surgically treated BPH specimens. The role of inflammation in BPH development was highlighted by its correlation with the prostate volume, metabolism and PSA level.

Relationship of Prostate-Specific Antigen (PSA) and Prostate Volume in Patients with Biopsy Proven Benign Prostatic Hyperplasia (BPH)

Abstract Benign prostatic hyperplasia (BPH) is one of the most common benign tumors in men with prevalence ranging from 50% for men in their 60s to 90% for men in their 80s. The researcher sought to determine the relationship of prostate-specific antigen (PSA) and prostate volume in patients with benign prostatic hyperplasia. This study was based on 33 cases of benign prostatic hyperplasia in the Department of Urology, RSUD Dr. Soetomo Surabaya that diagnosed by histopathology examination. Cases with malignancy, acute urinary retention and prostatitis were excluded. The variables of prostate-specific antigen and prostate volume were examined. The results of this study found that 33 men were enrolled with mean PSA 16,04 ng/ml and a mean prostate volume of 49,13 ml. Overall, 84,8% had PSA level &gt;4 ng/ml and 90,9% had prostate volume &gt;25 ml. Prostate-specific antigen has significant correlation with prostate volume (p=0,019; r=0,362). This study concluded that prostate-specific antigen and prostate volume showed a significant correlation. Keywords : benign prostatic hyperplasia, prostate specific antigen, prostate volumeCorrespondence : anny_sr@fk.unair.ac.id

Hematuria after Transrectal Prostate Biopsy: A Warning of Future Infection

Purpose: To identify the incidence and predictive factors of infectious complications in a prophylactic-controlled cohort of men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) at a single institution. Materials and Methods: A retrospective review was performed on 539 patients who underwent TRUS-Bx between 2010-2015. All patients received prophylactic Sulfamethoxazole/Trimethoprim and Levofloxacin prior to the biopsy. Charlson Comorbidity Index (CCI) was calculated for each patient. The characteristics of patients with and without infectious complications were compared using Fisher exact tests and student’s t-test. Results: 539 biopsies were performed. Mean age was 64 years, PSA was 17, prostate volume was 41 mL, and CCI score was 3. A total of 7 (1.3%) infectious complications were reported 48-72 hours after biopsy, with 2 (0.4%) developing sepsis. Analysis indicated no significant differences in mean age (p=0.544), PSA (p=0.881), prostate volume (p=0.532), or CCI score (p=0.499) among patients who developed infection. Individual components of the CCI revealed no statistically significant differences. Additional complications following biopsy included: hematuria (8.3%), rectal bleeding (1.3%), urinary urgency (0.9%), and new onset erectile dysfunction (0.6%). Hematuria was associated with the development of infectious complications (OR=8.75, CI 1.895–40.400, p=0.0055). Conclusions: Our cohort of patients undergoing TRUS-Bx had a lower infectious rate compared to that reported by the AUA (1.1% vs 5-7%). Although this study has limited power, CCI was poorly predictive of infectious complications following TRUS-Bx. Persistent hematuria following biopsy was associated with infectious complications. The clinical importance of hematuria following TRUS-Bx, if any, needs to be further clarified.

Prostatic Artery Embolization for Treatment of Symptomatic Benign Prostatic Hyperplasia Patients: Short- and Intermediate- term Outcome

Background: Benign prostatic hyperplasia (BPH) is one of the most common diseases in ageing men and is the most common cause of lower urinary tract symptoms (LUTS). There are several treatment options for benign prostatic hyperplasia. Aim: This study aims to evaluate the effectiveness, safety, morbidity and short- and intermediate-term results of prostatic artery embolization (PAE) for symptomatic BPH patients with moderate to severe LUTS. Methods: A prospective cohort study was carried out on 33 BPH patients, with moderate to severe LUTS. PAE was performed for patients and they were followed up at 3, 6 and 12 months post-procedural. Results and conclusion: Post-embolization follow-up results revealed significant reduction in the mean prostatic volume, post-voiding residual urine volume, severity of symptoms , total prostate specific antigen (PSA) level as well as significant improvement in patients’ quality of life (QoL). Meanwhile, no statistically significant changes were found in the erectile function post-procedural. Future researchers are recommended to replicate this study with longer follow-up periods, especially multi-center randomized controlled trials, using different types of embolic agents.

Post Intensity-Modulated Radiation Therapy Urinary Function for Prostate Cancer; A Prospective Study

Background: At present, there is a lack of evidence concerning urinary complications caused by intensity-modulated radiation therapy (IMRT) used for the management of prostate cancer (PCa). Objectives: This study aimed at identifying the nature and severity of post-IMRT urinary symptoms in patients with PCa. Methods: This prospective study was performed with consecutive patients, who had clinically localized PCa (cT1c-cT2c) and had undergone IMRT treatment from 2016 to 2019. At 1, 6, and 12 months of follow-up, medical history, physical information, prostate-specific antigen values, International Prostate Symptom Score (IPSS), medication use, Radiation Therapy Oncology Group (RTOG), acute and late toxicity, and Q max were collected. Results: A total of 127 patients with a mean age of 71.04 ± 7.1 years received IMRT and underwent 12 months of follow-up. The mean IPSSs at baseline versus those at 1, 6, and 12 months after IMRT was 14.5 ± 6.8 versus 13.3 ± 6.1, 12.3 ± 5.3, and 10.4 ± 4.2, respectively (P &lt; 0.000). The mean prostate volume was 38.2 ± 12.1 cc. At the last follow-up, 31 patients (24.4%) took genitourinary (GU) medications. Conclusions: This study showed that the majority of GU side effects caused by primary IMRT for PCa treatment are transient. Treatment triggered an acute increase in obstructive urinary symptoms, which peaked during the first month after IMRT. In most patients, in the course of 6 months, symptoms returned to baseline.

Tadalafil Improves Nocturia and Nocturia-Related Quality of Life in Patients with Benign Prostatic Hyperplasia (KYU-PRO Study)

Introduction: Tadalafil improves lower urinary tract symptoms (LUTS) including nocturia. However, the effect of tadalafil on the nocturia-related quality of life (QoL) is still unknown. Objective: The effects of tadalafil on nocturia and nocturia-related QoL were evaluated prospectively in patients with benign prostatic hyperplasia (BPH) as a multicenter study. Methods: Eligible men were ≥40 years with nocturia ≥2 and a prostate volume ≥20 mL. Patients were asked to complete a self-report questionnaire on the International Prostate Symptom Score (IPSS), the Nocturia Quality of Life questionnaire (N-QoL) and the International Index of Erectile Function 5 (IIEF5). Urinary frequency volume charts (FVCs) were also evaluated. These measures were evaluated at baseline, and after 4, 8, and 12 weeks of tadalafil administration (5 mg once daily). Results: Thirty-one patients with a mean age of 74 years, a mean prostate volume of 31 mL, and a mean prostate-specific antigen level of 2.8 ng/mL were included. Treatment with tadalafil significantly improved their nocturia after 4 weeks, and these improvements were maintained for the 12-week treatment period. Total N-QoL score in new patients and several N-QoL items (inadequate sleep at night and overall bother) in all patients improved significantly after tadalafil treatment. FVCs revealed a significant improvement in the number of hours of undisturbed sleep (HUS) after treatment with tadalafil. No serious adverse events were observed. Conclusions: This study indicates that tadalafil 5 mg once daily improves nocturia, nocturia-related QoL, and HUS in BPH patients with nocturia. These results suggest that tadalafil can offer a clinically meaningful treatment option for BPH patients with nocturia.

P-02-49 Waterablation of the Prostate for the Treatment of Lower Urinary Tract Symptoms in Men With Benign Prostatic Hyperplasia: First Italian Multicenter Experience after 1-Month of Follow-Up

Waterablation is gaining new interest in treating lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The Aquabeam system uses high-velocity water jets to robotically ablate prostatic tissue under real-time ultrasound guidance, with hemostasis achieved via a catheter balloon tamponade and a novel traction device or electrocautery. The aim of this study was to describe our preliminary outcomes following Waterablation procedure. Waterablation was performed in 36 patients with symptomatic BPH in a multicenter prospective study. Baseline, peri-operative and 1-month urinary function data were collected, including uroflowmetry, international prostate symptom score (IPSS), IPSS-Quality of life (IPS-QoL) and post void residual (PVR). Mean age was 67.5 (SD 1.83), baseline mean IPSS was 20.4 (SD 1.15), baseline mean peak flow was 9.05 (SD 0.65) and mean prostate volume was 85.9 cc (SD 6.08). After 1 month of surgery, mean change of peak flow was +7.94 ml/s (SD 1.51)(p< 0.01), of IPSS was -10.2 (SD 2.06)(p< 0.01), of PVR -80.2 cc (SD 26.26) (p< 0.01) and IPSS-QOL was -2 (SD 4.11)(p< 0.01). Median of catheterization (days) was 3.0 (SD 3.1) and median of hematuria 1.0 (SD 1.33) while the rate of post-operative antegrade ejaculation was 80.0% (30/6).

MEASUREMENT OF NORMAL SIZE OF PROSTATIC GLAND IN NORMAL SUDANESE MEN MARCH- OCTOBER 2019

Background: The prostate may become larger and begin to cause problems as male ages. Ultrasound is a commonly used imaging modality for the assessment of the prostate.&#x0D; Objective: The aim of this study was to identify the normal measurements (volume and diameters) of the prostate gland in Khartoum state Sudan in normal Sudanese.&#x0D; Method: This descriptive study of the study was done in Sudan teaching hospital, from March –to October 2019. 60 patients were randomly selected, their age ranged from 20 to 60 years; patients with symptoms related to prostate pathologies were excluded. Transabdominal ultrasound scanning by3.5 MHz probes was performed. And the Maximum length, width, and depth of the prostate diameters were obtained as well as the prostate volumes.&#x0D; Results: The results of the study revealed that the prostate length, width and thickness Diameters mean values were (4.88) cm, (3.37) cm, and (4.55) cm respectively, the Mean prostate volume obtained from the above parameters was18.65 ml. The study also showed that there was an increase in the prostate volume in relation to an increase in the patient's age and weight. Transabdominal ultrasound is a respectful approach and should be used confident pathologies among Sudanese and for normal measurements.

Use of 70- to 150-μm Radiopaque Spherical Embolics for Prostatic Artery Embolization

This retrospective report describes treatment of 21 patients who underwent prostatic artery embolization using 70- to 150-μm radiopaque microspheres for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Seventeen patients (81%) received successful bilateral prostatic artery embolization. At a mean follow-up of 42 days (range, 25–59 days), patients showed improvement in International Prostate Symptom Score (n = 11; mean = 10.6; P = .001), quality of life score (n = 17; mean = 2.0; P = .02), and International Index of Erectile Function (n = 17; mean = 9.3; P = .01). The mean prostate volume reduction was 28 mL (16.2%; P = .003). Nontarget embolization occurred twice, resulting in 1 minor adverse event of hematospermia.

Targeted and systematic cognitive freehand-guided transperineal biopsy: is there still a role for systematic biopsy?

To assess whether targeted cognitive freehand-assisted transperineal biopsies using a PrecisionpointTM device still require additional systematic biopsies to avoid missing clinically significant prostate cancer, and to investigate the benefit of a quadrant-only biopsy approach to analyse whether a quadrant or extended target of the quadrant containing the target only would have been equivalent to systematic biopsy. Patients underwent combined systematic mapping and targeted transperineal prostate biopsies at a single institution. Biopsies were performed using the Precisionpoint device (Perineologic, Cumberland, MD, USA) under either local anaesthetic (58%, 163/282), i.v. sedation (12%, 34/282) or general anaesthetic (30%, 85/282). A mean (range) of 24 (5-42) systematic and 4.2 (1-11) target cores were obtained. Magnetic resonance imaging (MRI) scans were reported using the Likert scale. Clinically significant cancer was defined as Gleason 7 or above. Histopathological results were correlated with the presence of an MRI abnormality within a spatial quadrant and the other adjoining or non-adjoining (opposite) quadrants. Histological concordance with radical prostatectomy specimens was analysed. A total of 282 patients were included in this study. Their mean (range) age was 66.8 (36-80) years, median (range) prostate-specific antigen level 7.4 (0.91-116)ng/mL and mean prostate volume 45.8 (13-150) mL. In this cohort, 82% of cases (230/282) were primary biopsies and 18% (52/282) were patients on surveillance. In all, 69% of biopsies (195/282) were identified to have clinically significant disease (Gleason ≥3 + 4). Any cancer (Gleason ≥3 + 3) was found in 84% (237/282) of patients. Of patients with clinically significant disease, the target biopsies alone picked up 88% (171/195), with systematic biopsy picking up the additional 12% (24/195) that the target biopsies missed. This altered with Likert score; 73% of Likert score 3 disease was detected by target biopsy, 92% of Likert score 4 and 100% of Likert score 5. Target biopsies with additional same-quadrant-only systematic cores picked up 75% (18/24) of significant cancer that was missed on target only, found in the same quadrant as the target. Systematic biopsy is still an important tool when evaluating all patients referred for prostate biopsy, but the need is decreased with increasing suspicion on MRI. Patients with very high suspicion of prostate cancer (Likert score 5) may not require systematic cores, unless representative surrounding biopsies are required for other specific treatments (e.g. focal therapy, or operative planning). More prospective studies are needed to evaluate this in full.

The Impact of Three Different Bladder Neck Reconstruction Techniques on Urinary Continence after Laparoscopic Radical Prostatectomy.

Objective: To evaluate the feasibility of three bladder neck reconstruction (BNR) techniques in laparoscopic radical prostatectomy (laparoscopic RP) and their effects on urinary continence. Methods: We retrospectively analyzed 121 patients with organ-confined prostate cancer, who underwent laparoscopic RP in our center from March to December 2018. Three BNR techniques-zero o'clock reconstruction (ZOR), six o'clock reconstruction (SOR), and three/nine o'clock reconstruction (T/NOR)-applied in patients with large bladder opening after prostate resection are described comprehensively. Demographic and perioperative data were collected and analyzed using Pearson's chi-square and one-way analysis of variance test. Multivariate analysis was performed to explore predictors that affected continence recovery in 24 hours, 1 month, 3 months, and 6 months after catheter removal. Results: Laparoscopic RP was performed in all patients, wherein 37, 35, 34, and 15 patients underwent bladder neck preservation, ZOR, SOR, and T/NOR techniques, respectively. There were more high-risk patients and larger mean prostate volume in groups with BNR techniques. Perioperatively, patients with reconstruction techniques had longer operation and anastomosis time, more estimated blood loss, and more positive margin status. Nevertheless, there was no significant difference among four groups regarding continence recovery in 24 hours, 1 month, 3 months, and 6 months after catheter removal. On multivariable analysis, positive apical margin and long anastomosis time were independent adverse predictors of continence recovery in 24 hours. Large prostate volume and positive apical margin were adverse factors of continence recovery at 1, 3, and 6 months. Conclusion: Three different kinds of BNR techniques were safe and feasible in laparoscopic RP and had no different impact on continence recovery. Positive apical margin, large prostate volume, and long anastomosis time were independent adverse predictors of continence.

Useful parameters to predict the presence of detrusor overactivity in male patients with lower urinary tract symptoms.

This study aimed to identify the easily obtainable parameters that predict the presence of detrusor overactivity (DO) in male patients with lower urinary tract symptoms (LUTS), because urodynamic studies cannot be performed in all cases. A total of 605 treatment-naïve men with non-neurogenic LUTS who underwent subjective and objective evaluations were retrospectively reviewed. We divided patients into two groups (the DO and the non-DO group) according to the presence or absence of DO as determined by urodynamic data and compared the clinical parameters between the two groups to identify clinical signs associated with DO. Of the 605 patients with a mean age of 69.8 years and a mean prostate volume of 45.4 mL, 319 (52.7%) had DO, while DO was not detected in 286 (47.3%). Men with DO were significantly older and had greater prostate volume, longer intravesical prostatic protrusion (IPP), higher international prostate symptom score, higher overactive bladder symptom score (OABSS), smaller bladder capacity, and higher bladder outlet obstruction than those without DO. In a multivariate logistic regression analysis, higher OABSS-urgency subscore and OABSS-urgency urinary incontinence (UUI) subscore and longer IPP were significant predictive signs of DO. Receiver operating characteristic curve analysis identified 3 points, 1 point, and 8.0 mm as the optimal cut-off values for OABSS-urgency subscore, OABSS-UUI subscore, and IPP, respectively, for the diagnosis of DO. Higher OABSS-urgency subscore, higher OABSS-UUI subscore, and longer IPP were found to be useful parameters to predict the presence of DO in male patients with LUTS.

Randomized Comparison of Prostatic Artery Embolization versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia

PurposeTo compare clinical and functional outcomes of prostatic artery embolization (PAE) with those of transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Materials and MethodsNoninferiority randomized trial was conducted involving men over 60 years of age with LUTS secondary to BPH. From November 2014 to January 2017, 45 patients were randomized to PAE (n = 23) or to TURP (n = 22). PAE was performed with 300- to 500-μm microspheres with the patient under local anesthesia, whereas bipolar TURP was performed with the patients under spinal or general anesthesia. Primary outcomes were changes in peak urinary flow (Qmax) and international prostate symptoms score (IPSS) from baseline to 12 months. Quality of life (QoL), and prostate volume (PV) changes from baseline to 12 month were secondary outcomes. Adverse events were compared using the Clavien classification. ResultsMean Qmax increased from 6.1 mL/s in the PAE group and from 9.6 mL/s in the TURP patients (P = .862 for noninferiority), and mean IPSS reduction was 21.0 points for PAE and 18.2 points for TURP subjects (P = .080) at 12 months. A greater QoL improvement was reported in the PAE group (3.78 points for PAE and 3.09 points for TURP; P = .002). Mean PV reduction was 20.5 cm³ (34.2%) for PAE subjects and 44.7 cm³ (71.2%) for TURP subjects (P < .001). There were fewer adverse events reported in the PAE group than in the TURP group (n = 15 vs n = 47; P < .001). ConclusionsReduction of LUTS in the PAE group was similar to that in the TURP group at 12 months, with fewer complications secondary to PAE. Long-term follow-up is needed to compare the durability of the symptomatic improvement from each procedure.

MP06-08 DETRUSOR PRESSURES ARE ASSOCIATED WITH COLLAGEN TYPE III EXPRESSION IN THE DETRUSOR OF PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research & Pathophysiology (MP06)1 Apr 2020MP06-08 DETRUSOR PRESSURES ARE ASSOCIATED WITH COLLAGEN TYPE III EXPRESSION IN THE DETRUSOR OF PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA Carlos Bellucci*, Thiago Hemerly, Vanessa Guimarães, Nayara Viana, Gabriel Camargo, Sabrina Reis, Homero Bruschini, Miguel Srougi, Katia Leite, and Cristiano Gomes Carlos Bellucci*Carlos Bellucci* More articles by this author , Thiago HemerlyThiago Hemerly More articles by this author , Vanessa GuimarãesVanessa Guimarães More articles by this author , Nayara VianaNayara Viana More articles by this author , Gabriel CamargoGabriel Camargo More articles by this author , Sabrina ReisSabrina Reis More articles by this author , Homero BruschiniHomero Bruschini More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , Katia LeiteKatia Leite More articles by this author , and Cristiano GomesCristiano Gomes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000820.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Studies with patients with benign prostatic hyperplasia (BPH) and animal models of Bladder outlet obstruction (BOO) have shown increased deposition of collagen in the detrusor and increased type III/type I collagen ratio. Collagen deposition in the detrusor has been associated with decreased compliance and detrusor underactivity. The mechanisms involved in the BOO-associated changes in the detrusor extracellular matrix are not well understood. It has been hypothesized that high detrusor pressure promotes increased bladder intramural tension, decreasing blood flow and leading to hypoxia and subsequent fibrosis. We evaluated the gene expression of types I and III collagen (COL I and COL III) in the detrusor of men with BOO due to BPH and its correlation with urodynamic parameters. METHODS: Twenty-eight consecutive patients undergoing open prostatectomy for BPH were evaluated. Urodynamics was performed in all patients preoperatively. A bladder specimen from the dome was obtained during prostatectomy. Nine cadaveric organ donors composed the control group. Detrusor biopsies were prepared for relative gene expression analysis with quantitative real-time polymerase chain reaction of COL I and COL III. Data were expressed as medians and interquartile ranges or absolute values and fractions. Spearman correlation coefficient was used to investigate the association between gene expression and urodynamic parameters, including maximum cystometric capacity (MCC), bladder compliance (BC), maximum flow rate (Qmax), detrusor [email protected] flow rate (PdetQmax), bladder outlet obstruction index (BOOI) and bladder contractile index (BCI). RESULTS: Mean age was 67.0 ± 7.4 years and mean prostate volume was 133.8 ± 43.9 cm3. Mean International Prostatic Symptom Score 23.5 ± 6.2. In comparison with controls, patients with BPH had significant overexpression of COL I and COL III, (Table 1). A positive correlation between COL III expression and PdetQmax, BOOI and BCI was found (Table 2). CONCLUSIONS: Gene expression of collagens I and III is increased in the detrusor of men with BPH. We showed a positive correlation between COL III expression and PdetQmax, BOOI and BCI, which is consistent with the hypothesis that high detrusor pressures decrease blood flow to the bladder leading to fibrosis. Source of Funding: Sao Paulo Research Foundation - FAPESP © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e53-e54 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlos Bellucci* More articles by this author Thiago Hemerly More articles by this author Vanessa Guimarães More articles by this author Nayara Viana More articles by this author Gabriel Camargo More articles by this author Sabrina Reis More articles by this author Homero Bruschini More articles by this author Miguel Srougi More articles by this author Katia Leite More articles by this author Cristiano Gomes More articles by this author Expand All Advertisement PDF downloadLoading ...

MP25-10 AQUABLATION FOR BENIGN PROSTATIC HYPERPLASIA IN LARGE PROSTATES (80-150CC)

INTRODUCTION AND OBJECTIVE: To report 2 year safety and effectiveness outcomes of the Aquablation procedure for the treatment of men with symptomatic BPH and large-volume prostates. METHODS: 101 men with moderate-to-severe BPH symptoms and prostate volumes of 80-150cc underwent a robotic-assisted Aquablation procedure in a prospective multicenter international clinical trial. Functional and safety outcomes were assessed at 2 years postoperatively. RESULTS: Mean prostate volume was 107cc (range 80-150). Mean operative time was 37 minutes and mean Aquablation resection time was 8 minutes. The average length of hospital stay following the procedure was 1.6 days. IPSS scores improved from 23.2 at baseline to 5.1 at 2 years (change score of 18.1 points). At baseline, Qmax was 8.7 cc/sec and improving to 16.6 cc/sec at 24 months. Improvements in both IPSS and Qmax were immediate and sustained throughout follow-up. The average annual retreatment occurrence was 0%. CONCLUSIONS: The Aquablation procedure is demonstrated to be safe and effective in treating men with large prostates (80-150cc) after 2 year of follow-up, with an acceptable complication rate and without a significant increase in procedure or resection time compared to smaller sized glands. Two-year results held consistent with one year outcomes. ClinicalTrials.gov number, NCT03123250. Source of Funding: ClinicalTrials.gov number, NCT03123250

PD43-06 IMPACT OF PROSTATIC SHAPE ON THE DIFFICULTY OF ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD43)1 Apr 2020PD43-06 IMPACT OF PROSTATIC SHAPE ON THE DIFFICULTY OF ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY Ken Kamisawa*, Kazuhiro Matsumoto, Toshikazu Takeda, Kimiharu Takamatsu, Yota Yasumizu, Nobuyuki Tanaka, Shinya Morita, Takeo Kosaka, Ryuichi Mizuno, Hiroshi Asanuma, and Mototsugu Oya Ken Kamisawa*Ken Kamisawa* More articles by this author , Kazuhiro MatsumotoKazuhiro Matsumoto More articles by this author , Toshikazu TakedaToshikazu Takeda More articles by this author , Kimiharu TakamatsuKimiharu Takamatsu More articles by this author , Yota YasumizuYota Yasumizu More articles by this author , Nobuyuki TanakaNobuyuki Tanaka More articles by this author , Shinya MoritaShinya Morita More articles by this author , Takeo KosakaTakeo Kosaka More articles by this author , Ryuichi MizunoRyuichi Mizuno More articles by this author , Hiroshi AsanumaHiroshi Asanuma More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000930.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted laparoscopic radical prostatectomy (RALP) is a valuable treatment option for clinically localized prostate cancer . However, RALP for larger prostates is associated with greater blood loss and longer operative times. Meanwhile, there are sometimes easy cases with large prostates, and vice versa. Therefore, we focused the impact of prostatic shape on the surgical difficulty. We hypothesized that RALP for spherical prostates is more difficult than non-spherical ones. METHODS: We retrospectively reviewed 211 patients who underwent RALP between 2017 and 2019, excluding those who received neoadjuvant therapy. All surgeries were performed by two surgeons, each of whom had performed more than 50 RALP procedures by 2017. Patient age, prostate volume, prostate sphericity, nerve-sparing procedure, and extent of lymphadenectomy were assessed. Prostate sphericity was evaluated by “the roundness” of the prostate, which was defined as a ratio of the radius of the inscribed and circumcircle that share the same center at the largest axial slice by MRI. The console time (CT) was employed as an objective index for the surgical difficulty. RESULTS: The mean patient age was 67 years old (range 45 to 78). The mean prostate volume was 34 cc (range 14 to 88) and mean prostate roundness was 0.55 (range 0.24 to 0.90). Bilateral and unilateral nerve-sparing procedures were performed for 11 (5%) and 47 (22%) cases. The extent of lymphadenectomy was "limited" in 98 (46%) and "standard" in 90 (43%) patients. The mean CT was 194 minutes (range 95 to 296). We found no significant difference in CT regarding the nerve-sparing procedure or extent of lymphadenectomy. Prostate volume and roundness (Figure 1a) were positively correlated with the CT. Furthermore, subgroup analysis with 56 patients with a large prostate volume (> 40cc) revealed that prostate roundness was comparatively strongly correlated with the CT (Figure 1b). CONCLUSIONS: This study demonstrated that the spherical shape of the prostate affects the difficulty of RALP, especially in patients with a large prostate. These results suggested that RALP for large and spherical prostates requires advanced surgical techniques. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e902-e902 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ken Kamisawa* More articles by this author Kazuhiro Matsumoto More articles by this author Toshikazu Takeda More articles by this author Kimiharu Takamatsu More articles by this author Yota Yasumizu More articles by this author Nobuyuki Tanaka More articles by this author Shinya Morita More articles by this author Takeo Kosaka More articles by this author Ryuichi Mizuno More articles by this author Hiroshi Asanuma More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement PDF downloadLoading ...